8.1.4 - Alcohol addiction treatments

Aversion conditioning

Aversion therapy aims to change alcohol-related responses by associating alcohol cues with an unpleasant experience.

The learning mechanism is classical conditioning. In a chemical aversion programme, an emetic produces nausea and vomiting: these are initially an unconditioned response to the emetic's effects. Alcohol's smell, taste or other cues are paired with that experience. After conditioning, alcohol cues are intended to evoke aversion, reducing their attraction and the likelihood of drinking. This changes a cue-response association rather than teaching a new coping skill. A response to alcohol is not the same thing as a response to every drink; discrimination between alcohol and other drinks matters.

Chemical aversion should be distinguished from disulfiram used as a deterrent. Disulfiram inhibits the enzyme aldehyde dehydrogenase involved in alcohol metabolism. If alcohol is consumed, acetaldehyde can accumulate and cause an unpleasant and potentially dangerous reaction. Knowing this consequence can deter drinking. A person can therefore avoid alcohol without repeatedly experiencing the reaction; deterrence does not itself establish that classical conditioning occurred. Current NICE alcohol guidance requires medical assessment and supervision and explains serious interaction risks. It is not a learner experiment or a recommendation to combine disulfiram with alcohol.

Aversion can target a rewarding cue quickly, but an association may weaken when alcohol cues are encountered without the aversive outcome or outside the treatment setting. It also leaves possible reasons for drinking, such as coping with stress or maintaining belonging, less directly addressed. Informed consent, voluntary participation and medical assessment matter because discomfort is deliberately involved; compulsory treatment raises further social-control concerns.

Cognitive-behavioural relapse prevention

Cognitive-behavioural therapy changes alcohol-related thoughts and behaviour while teaching responses to situations that could lead to renewed use.

Cognitive-behavioural therapy (CBT) connects thoughts, feelings, situations and actions. The therapist and client identify a drinking pattern: for example, conflict produces distress, the person thinks “only alcohol will help”, drinking brings immediate relief, and the relief maintains the behaviour. This is an individual formulation rather than a claim that every client has the same irrational belief.

The cognitive work examines expectations and interpretations. The client may test whether alcohol is really the only coping option and develop a more realistic belief about being able to tolerate distress or seek support. Behavioural work rehearses alternatives such as assertive refusal, problem solving, contacting support or engaging in a rewarding non-drug activity. Practice makes an alternative response available when the old trigger occurs. The NIAAA evidence-based treatment resource identifies managing thoughts, feelings, behaviour and triggers as central CBT work.